Answers to other questions may be found in our extensive list of web resources.

What causes transsexualism?

There are several theories but no one knows for sure. It could be hardwired — that is caused by genes. It could be a result of psychological factors — upbringing, conditioning, the socialization process. It could be environmental pollution — chemicals that are ingested by a pregnant woman that mimic human hormones and affect the development of the brain in the fetus. Or it may be a combination of several or all of these.

It’s a fascinating question but don’t let the search for an answer distract you. It’s more important to figure out who you are now and develop a game plan that helps you get on with your life.

What is the incidence of transsexualism?

There is no definitive answer to this question. Some estimates put the number of MTF transsexuals at one in 10,000 and the number of FTM transsexuals at one in 30,000. However, judging by the number of transsexuals we know and by the number of people who have undergone reassignment surgery, we suspect the number is much higher in both categories. In fact, one estimate puts the number at between one in 250 and one in 500.

How do I know whether I’m a transsexual?

Humans are complicated and any one individual can have a variety of traits. You might be a cross-dresser with some cross-gender leanings. Or you might be a transsexual with some psychological baggage that could loosely be termed a personality disorder.

In general, though, a transsexual feels out of synch with his or her body. There is an internal identity that is different from the external. The greater the difference between the internal image and the body one was born with, the greater the discomfort an individual will likely feel.

Can a psychiatrist help me figure out whether I’m a transsexual?

This will depend on the training and experience of the doctor. An experienced doctor, particularly one who works at a gender identity clinic, will be able to help you sort out your feelings. There is no guarantee you will like what you hear but their assessment will normally be fair and accurate.

If I am a transsexual, what are my options?

This will depend on your life situation and how strongly your cross-gender feelings are. Your basic options are to begin transition — or find a way to cope in your current life. Keep in mind that transsexualism is not a disease and therefore not “curable.” If you decide there are good reasons to continue in your birth sex, you will always have to deal with cross-gender feelings.

There are many reasons to decide against transition. First, you must be realistic about your physical traits. It can be tragic to change sex and find you can never be accepted in the new role because you don’t pass. Secondly, and perhaps more importantly, you must consider the possible loss of family, friends and career.

For these reasons, some transsexuals look for a middle ground that allows them to explore their inner self without sacrificing all the things they have built up in their lives. That might mean living part time at home or socially in the preferred role while continuing at work in the old role. It might mean you will take hormones that change the body and permit you to live in an androgynous or middle state.

If you think this is your path, it can be helpful to line up a counsellor or psychologist to help you find a balance in your life. It can also be helpful to share your feelings with an understanding family member or friend. Bottling up your feelings will make it difficult for you and may be asking for trouble. Remember, if you choose this route, you can always opt to go further along the road of transition later on — or go back to the old you.

What is the process of transition for a transsexual?

The process is roughly the same regardless of whether you are male-to-female or female-to-male. You will begin living in your preferred role (at first part time, but when you’re ready it will be full time); you will be assessed by a team, usually consisting of at least one psychologist and one psychiatrist; you will likely take hormones to change your body; you will change your legal documents to reflect your new name; you will inform friends and family; you may find that surgery is necessary.

How long does transition take?

For most people, the physical transition takes three to five years. The doctors doing the psychological assessment will require that you live full time in your new role, including working for a minimum of one year before they will authorize surgery. The WPATH guidelines specify a one-year period. The CAMH Gender Clinic requires a minimum of two years. The idea is to give you time to adjust to your new life, to ensure that it is the right decision before you undergo surgery.

If you are going from male to female, you will need time to undergo electrolysis to remove facial and body hair. Either way you go, it takes time for the hormones to mould your body. It also takes time to unlearn the body mannerisms, the speech patterns and behaviour that you may have learned in your earlier life.

How do I find doctors who will be comfortable dealing with transsexualism?

You can start by contacting a transgender support group in your area. If there is no group nearby, you may want to consider talking to your family doctor or a doctor you know to be gay or lesbian. Even if a doctor is uncomfortable with the issue, or is unfamiliar with it, he or she may be able to refer you to someone who can help. All doctors are required to keep anything you say confidential, so you needn’t fear that your request will become public knowledge.

If you wish to deal directly with a gender identity clinic, you will require a reference from a general practitioner, psychologist or psychiatrist in your area.

Are medical services covered by insurance?

Some are, but it depends on where you live. You will have to check with the doctor or clinic you are considering. You will also have to check with whatever insurance plans you use. In Manitoba, for example, some psychologists and psychiatrists will bill Manitoba Health. But others will bill you directly. Some doctors may be willing to bill you on a sliding scale that takes into account your income.

Manitobans referred to the CAMH gender identity clinic in Toronto will have to pay for transportation but will be reimbursed by Manitoba Health. CAMH will bill Manitoba Health directly for its assessment.

How do I acquire hormones?

Any family doctor, endocrinologist or psychiatrist can prescribe hormones. However, it’s unlikely you will be granted hormones until you have undergone some counselling, psychological assessment or physical examination.

Although a family doctor may be willing to prescribe hormones, he or she will probably want an endocrinologist to see you first to discuss the effects and determine a dosage.

What will hormones do for me?

Each person is affected to a different degree. For that reason, doctors prescribe different hormones and different dosages. In general, if you are F-M, you will see a reduction in body fat, accompanied by an increase in muscle mass. You will stop menstruating. Your voice will drop to a normal male range within six months to a year. You will develop normal male body hair patterns, including a beard . Depending on your genetic makeup and body chemistry, you may start balding.

If you are M-F, you will lose muscle mass and see a redistribution of body fat from the upper body to the hips and legs. You will develop breasts, although not usually larger than an A-cup size. The hair on most of your body will become very fine. Your skin will soften. If you were losing scalp hair, this will probably stabilize, although you will not regrow hair in bald spots. Your voice may soften slightly, but will remain in the male range.

I’m M-F, what’s the best way to get rid of body hair?

Electrolysis is the only method that works on any type of hair. But with advancements in laser technology, many people are reporting excellent results. Check with others who have undergone electrolysis or laser hair removal. They can describe their experiences and give you a referral to someone who is comfortable dealing with transgendered clients. Be aware that for most M-F transsexuals it will take a year to two years of intensive (weekly or every two weeks) electrolysis to remove a beard. If you have infrequent treatments, it will take many years. Laser is faster, but each session is more expensive.

How do I learn to act like others born into my preferred sex?

If you’re lucky, it will be automatic. Those who lived a gay or lesbian life before transition tend to blend into the new role very quickly and easily. It can be tougher for the so-called heterosexual transsexual. If you spent years living successfully as a male and now want to be accepted as female, you will have to undo the conditioned responses you learned to help you be accepted as a normal male.

Spend time watching how other people behave. Try practising what you see in the privacy of your own home. Later, practise in the company of supportive friends or a transgender support group. Don’t over-act — you’ll just draw attention to yourself.

What do I do about my voice?

If you are F-M, you won’t have much to worry about. Your voice will drop to a male range.If you are M-F, you will have to retrain your voice. The best bet is to ask your family doctor or psychologist to refer you to a speech therapist. With his or her help, you can develop a natural female voice. Without professional help, you may sound artificial or strain your vocal chords. Speech therapists are covered under medicare in Manitoba if you are referred by a doctor.

How do I tell my family and friends?

First, judge your relationship within your family and with your friends. Some transsexuals prefer the direct approach. They sit down with each person and tell them the full story at one time. Others prefer to bring it out bit by bit over months or even a year or so.

If you want to take the gradual approach, you can start by saying that you are feeling depressed or confused about yourself and have decided to start seeing a counsellor or psychiatrist to help you sort it out. Later, you can say you have some questions about your sexual identity that you need to sort out. This will spark questions about whether you are gay or whatever. You can respond by saying you haven’t decided what you are, but it’s important to figure it out.

Farther on, you can say that you and the counsellor are exploring whether you are dealing with gender dysphoria. You don’t have to use the word transsexual. Tell your family that gender dysphoria is a recognized condition in which a person’s gender identity is in conflict with his or her body. Tell them you are trying to find a way to cope with this condition but have made no decisions yet.

Later, say that you feel it’s important for you to explore your inner identity. That means you will start living part time in the new role, perhaps at social events hosted by transgender support groups, perhaps at home if you live alone. If by this time you decide that you want to change gender, you have prepared your family for it. They may not like it, but they will have had plenty of time to adjust.

I’m married and love my spouse, can I expect to keep the relationship if I decide to change gender?

We have seen many couples stay together when one undergoes a sex change, but that is the exception rather than the rule. Many wives or husbands are horrified to learn their spouse considers themselves to be a different gender. You must be prepared that your revelation will be met with anger and a feeling of betrayal.

The only way to guarantee the continuation of the relationship is to proceed through transition at a pace such that your partner is always OK with the next step before you take it.

Not so long ago, you had to be divorced before permission would be granted to undergo gender reassignment surgery. That has changed. In Canada, you can be married and undergo surgery. In effect, you and your spouse will now be a same-sex couple.

Is there any way I can learn to be happy with the sex I was born into?

Transsexualism is not a disease. That means there is no “cure”. If you stay in the original sex, you face a strong possibility that you will always be troubled by stress and depression. Yet, most people who identify themselves as transsexuals don’t end up having gender reassignment surgery. The key to learning to cope with it is to admit that you can’t handle it alone. Tell your spouse that you are feeling stressed and depressed (you don’t have to give the reason) and that you want to seek professional help. Find a counsellor or psychiatrist who is sympathetic and willing to take you on a long-term basis.

Will my kids accept me after transition?

If you have a good relationship with your children, the odds are you will come through transition all right. According to the Minneapolis Gender Identity Clinic, most children will develop some degree of acceptance. But be prepared that it may be a rocky road. At first, children may be angry and strike out with some hurtful comments. You will have to be patient and explain that they aren’t losing a parent; that you still love them; and that you will always be there for them.

How do I change my legal documents?

In Manitoba, the first step is to formally change your name with the Vital Statistics Agency. (Each province and state has an office that records births, deaths, marriages and name changes.) It will take several weeks to receive a document making it official. Once you have this, it’s just a matter of making the rounds of other government offices to change your name.

Is it better to be working or between jobs when I transition?

If you are going from male to female, it would probably be easier to do it on the job — so long as you can get the support of management and co-workers. At the minimum, it is best to be working when you start transition. The reason is money — transition is expensive.

You must be prepared to spend $5,000 to $7,000 on electrolysis or laser treatments to remove your facial and body hair. You may also decide you want some facial surgery if you want a more feminine nose, throat, jaw or forehead. Or you may need hair implants if you are thinning or balding. Surgery and hair transplants can cost tens of thousands of dollars. If you are unemployed or on social assistance, you won’t be able to do any of these things. And keep in mind that a beard will make it difficult to be accepted in the new role.

If you complete transition on the job, you can go to a new job in your new role and you will have a work record and reference to take with you in your new name. Some transsexuals have had difficulty getting the job they wanted because they transitioned between jobs and had no work record in their new roles.

If you are going from female to male, you can do it on the job or between jobs and should be able to do it smoothly. There are no major costs involved in Manitoba, unless you opt for penis surgery. Once you are on hormones, you will grow a beard, your voice will drop, and your body will become more muscular.

How do I handle transition on the job?

It is best to do this with the help of the psychologist or gender clinic that is assessing you. Have them write a letter addressed to an appropriate senior manager at your place of employment. The letter will explain your situation. Give the manager an idea of what time frame you are considering for the transition and the steps you will take.

Make sure you emphasize that the transition will not affect the quality of your work. Also emphasize that you have the best interests of the company in mind and want to minimize any disruption your transition may cause. Once management knows, you can start telling individual co-workers what you plan to do. By taking people aside and letting them know what’s happening, you will gain more sympathy and acceptance than if you just let them find out through the grape vine or suddenly turn up one day dressed differently.

It helps to tell co-workers that you understand some people will be shocked. You can put them at ease by saying you understand and accept that there will be gossip and jokes behind your back. You can also say that the process will be an adventure and an education for you as well as for them. Offer to answer any questions if you can. Don’t make demands about how others should respond. You don’t have to take abuse, but you can’t prevent natural human behaviour behind your back.

At some point, before you officially begin transition, the company should issue a letter to all employees explaining what you are about to do and that the company stands behind you. This will prevent harassment later on.

How do I arrange gender reassignment surgery?

You will need a reference from your psychiatrist to a surgeon clearing you for surgery. If you are paying for it yourself, you will make the arrangements directly with the surgeon’s secretary. If medicare is going to pay for it, check with your local office for its procedure.

The Winnipeg Transgender Group provides links to other organizations as a courtesy, and makes no representations regarding them or any information related thereto. Any questions, complaints or claims regarding these organizations must be directed to the appropriate organization.